Background

Women are more likely to present with genitourinary complaints immediately after exposure to interpersonal violence, but little is known about the long-term effects of violence on women’s urologic health, including their susceptibility to bladder pain and infections.

Objective

To determine whether lifetime interpersonal violence exposure and current posttraumatic stress disorder (PTSD) symptoms are associated with the prevalence or severity of painful bladder symptoms and a greater lifetime history of antibiotic-treated urinary tract infections in community-dwelling midlife and older women.

Study Design

We examined the cross-sectional data from a multiethnic cohort of community-dwelling women aged 40 to 80 years enrolled in a northern California integrated healthcare system. Women completed structured self-report questionnaires about their past exposure to physical and verbal/emotional intimate partner violence and sexual assault. The symptoms of PTSD were assessed using the PTSD checklist for the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, Civilian version. Additional structured self-report measures assessed the current bladder pain, other lower urinary tract symptoms, and the history of antibiotic-treated urinary tract infections. Multivariable logistic regression models examined self-reported interpersonal violence exposure history and current PTSD symptoms in relation to current bladder pain and antibiotic-treated urinary tract infection history.

Results

Among 1974 women (39% non-Latina White, 21% Black, 20% Latina, and 19% Asian), 22% reported lifetime interpersonal violence exposure, 22% reported bladder pain, and 60% reported a history of ever having an antibiotic-treated urinary tract infection. Lifetime experiences of sexual assault (odds ratio, 1.39; [95% confidence interval, 1.02–1.88]) and current PTSD symptoms (odds ratio, 1.96; [95% confidence interval, 1.45–2.65]) were associated with current bladder pain. A lifetime experience of physical intimate partner violence was associated with having a urinary tract infection at any time in life previously (odds ratio, 1.38; [95% confidence interval, 1.00–1.86]), as was emotional intimate partner violence (odds ratio, 1.88; [95% confidence interval, 1.43–2.48]), sexual assault (odds ratio, 1.44; [95% confidence interval, 1.09–1.91]), and current PTSD symptoms (odds ratio, 1.54; [95% confidence interval, 1.16–2.03]).

Conclusion

In this ethnically diverse, community-based cohort, lifetime interpersonal violence exposures and current PTSD symptoms were independently associated with current bladder pain and the lifetime history of antibiotic-treated urinary tract infections in midlife to older women. The findings suggest that interpersonal violence and PTSD symptoms may be underrecognized markers of risk for urologic pain and infections in women, highlighting a need for trauma-informed care of these issues.

中文翻译：

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社区中年老年妇女的人际暴力和膀胱疼痛症状

背景

女性更有可能在遭受人际暴力后立即出现泌尿生殖系统疾病，但人们对暴力对女性泌尿系统健康的长期影响知之甚少，包括她们对膀胱疼痛和感染的易感性。

客观的

确定终生接触人际暴力和当前的创伤后应激障碍 (PTSD) 症状是否与社区中年和老年女性膀胱疼痛症状的患病率或严重程度以及抗生素治疗的尿路感染的终生历史相关。

学习规划

我们检查了来自加利福尼亚北部综合医疗保健系统的 40 至 80 岁社区居住女性的多种族队列的横断面数据。女性完成了关于她们过去遭受身体和言语/情感亲密伴侣暴力和性侵犯的结构化自我报告问卷。使用精神疾病诊断和统计手册-第四版民用版的 PTSD 检查表评估 PTSD 的症状。其他结构化的自我报告措施评估了当前的膀胱疼痛、其他下尿路症状和抗生素治疗的尿路感染史。

结果

在 1974 名女性（39% 非拉丁裔白人、21% 黑人、20% 拉丁裔和 19% 亚裔）中，22% 报告终生遭受人际暴力，22% 报告膀胱疼痛，60% 报告曾经使用过抗生素-治疗的尿路感染。性侵犯的一生经历（优势比，1.39；[95% 置信区间，1.02–1.88]）和当前的 PTSD 症状（优势比，1.96；[95% 置信区间，1.45–2.65]）与当前的膀胱疼痛相关。一生中遭受亲密伴侣暴力的经历与之前生命中任何时候的尿路感染有关（优势比，1.38；[95% 置信区间，1.00-1.86]），情感亲密伴侣暴力也是如此（优势比， 1.88；[95% 置信区间，1.43–2.48]），性侵犯（优势比，1.44；[95% 置信区间，1.09–1.91]），

结论

在这个种族多样化、以社区为基础的队列中，终生人际暴力暴露和当前的 PTSD 症状与当前的膀胱疼痛和中年老年女性使用抗生素治疗的尿路感染的终生病史独立相关。研究结果表明，人际暴力和 PTSD 症状可能是女性泌尿系统疼痛和感染风险的未被充分认识的标志，突出了对这些问题进行创伤知情护理的必要性。